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Letters
Fit to Return
Health Declaration
Covid19
OnlineDoc eLetter
Health Declaration for New Job
Only
€2
3
Health Declaration Certificate
First Name
Last Name
Date Of Birth
Email
Phone Number
Address
Please Specify Your Gender:
*
Male
Female
Do you suffer from, or have you ever had any of the following Conditions? (Please tick the box if you have any of the codition listed below)
*
Required
Chest Pain, heart condition or raised blood pressure?
Blackouts / seizures or recurrent Headaches
Depression, mental illness or nervous breakdown
Back PAIN or joint problems
Diabetes, thyroid or other gland trouble
Hearing defect, ear infections, dizziness or problems with balance
Alcohol or drug addition
Any other accident, operation or illness
Any illness including Jaundice, HIV, Hepatitis or any other communicable diseases
Have you ever left your job due to ill health or medically retired?
Are you Registered as a disabled person, if so, what disability
Have you travelled to a high rate tuberculosis country within the previous 5 years and have you been screened
Any other current or recent medical condition or treatment which might affect your attendance or performance at work
Any illness or medical condition that prevented you from attending work on your normal duties or activities for more than one week during the past year
Non of them
If you have any condition that listed above, Please explain here.
If you have any Health Declaration form, Please upload here. (Only PDF format)
Upload File
Upload supported file (Max 15MB)
I confirm that the answers I have provided for the above questions are true and accurate to the best of my knowledge.
*
I Confirm
Proceed to Checkout
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